Life Skills Wyoming - Employment Application
Last Name *
Your answer
First Name *
Your answer
Middle Initial
Your answer
Social Security Number (required upon hire)
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Email *
Your answer
Mailing Address
Your answer
Physical Address
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Highest Grade Completed *
Special Training or Education in a Related Field
Your answer
Do you have a high school diploma or GED certificate? *
Name and Location of School *
Your answer
How many years of work experience do you have? *
Your answer
Please rate your safety awareness on the job. *
Please rate your ability to follow directions. *
Are you currently CPR/First Aid certified? *
CPR/First Aid Certification Expiration Date
MM
/
DD
/
YYYY
Are you willing to wear a swimsuit and join participant in the pool? *
Have you ever been convicted of a criminal offense in a court of law? *Answering YES to this question does not constitute an automatic bar to employment. *
If you answered YES to the previous question please provide dates, details and penalties for each occurrence. Do not include minor traffic violations.
Your answer
Do you have a clean Motor Vehicle Report? *
If you answered NO to the previous question, please provide details about your driving history.
Your answer
Do you have any medical or emotional conditions that would limit your ability in performance of job duties? *
If you answered YES to the previous question, please explain.
Your answer
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